April 2010

Dear Readers:

In some ways it all seems like a dream.  We have been talking about the possibility of comprehensive healthcare reform for the last year, and somehow, suddenly, with the stroke of a pen, it is a reality.  Our attention now is on the implementation of the Patient Protection and Affordable Care Act (HR 3590) which will bring significant changes to the substance use treatment community.  By 2019 it is estimated that ninety-five percent of all Americans will have some type of healthcare coverage, either through private insurance or through Medicaid.  Both of these programs must provide coverage for substance use and mental illness treatment and abide by the provisions contained in the Mental Health Parity and Addiction Equity Act.  Substance use treatment organizations will have to have the infrastructure to contract with private insurance and Medicaid, to submit claims electronically, to have staff credentialed, to meet access standards, and to monitor their cash flow in order to survive in this new environment.

This issue of Addiction News Now contains links to many useful resources from the National Council to assist organizations understand and prepare for these changes.  These include a series of fact sheets and timelines to better understand the components of healthcare reform and a recently-released report, “Substance Use Disorders and the Person-Centered Healthcare Home”. You will also see resources on contracting with managed care organizations, on the evidence and evolving models of healthcare integration, and on the adoption and meaningful use of health information technology.

I encourage you to take advantage of the National Council’s Healthcare Reform Implementation webinar series and to share with us your questions and concerns about healthcare reform.  Together we must Fight for Our Future!

Sincerely,

Charles Ingoglia, MSW
Vice President, Public Policy

ON THE HILL
 

House HIT Bill Which Would Allow CBHOs to Access Federal HIT Funding
The American Recovery and Reinvestment Act of 2009 (ARRA) provides over $19 billion to incentivize medical providers to use health information technology (HIT) to help foster the adoption and meaningful use of electronic health records and other HIT. While psychiatrists and nurse practitioners providing addiction and mental health services within community behavioral health organizations (CBHOs) can access these incentive payments, all other providers who work within CBHOs cannot. In addition, while hospitals are eligible to receive facility payments under the Medicare and Medicaid incentive programs, CBHOs are excluded from facility payments, thus greatly limiting the likelihood of clients fully benefiting from the proven benefits of provider adoption of Health IT.

In order to address these concerns, The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040) will ensure that community-based addiction and mental health providers will be eligible for the electronic health record incentive and facility payments. The original sponsors of the bill, Representatives Patrick Kennedy (D-RI), Tim Murphy (R-PA), Gene Green (D-TX), and Alcee Hastings (D-FL), are seeking additional cosponsors so as to build support for the bill. Your Representatives need to hear from you about your support for this important bill.

ACT NOW: Send a message to your Representative in support of HR 5040!

Visit the National Council’s website to review a fact sheet on HR 5040.

Senate Approves Bill to Reduce Inequality in Cocaine Sentencing
The Senate on March 18 voted by unanimous consent to approve the Fair Sentencing Act of 2009 (S. 1789). This bill would reduce the disparity in criminal penalties for the possession of crack cocaine and powder cocaine so that the quantity of powder cocaine that triggers an automatic prison sentence is only 18 times greater than the amount of crack cocaine that triggers the same sentence. Currently, the ratio is 100:1.  An earlier version of the bill would have equalized the criminal penalties for the two kinds of cocaine, but this provision was removed during consideration by the Senate Judiciary Committee. Although the bill as passed does not provide for full equality in sentencing, it is a major step forward in sentencing policy. S. 1789 has been sent to the House, where a similar bill (H.R. 3245, the Fairness in Cocaine Sentencing Act), has been approved by the House Judiciary Committee with bipartisan support and is awaiting a hearing by the House Energy and Commerce Committee.

IN THE NEWS

National Council Releases Several New Resources on Healthcare Reform & Other Legislation of Interest
There are several new healthcare reform resources available on the National Council website:

• Recording of Webinar, “Healthcare Reform: What Happens Next?: Review the slides and recording from our first healthcare reform implementation webinar, led by Linda Rosenberg, CEO & President, and Chuck Ingoglia, Vice President, Public Policy. This webinar reviewed the major components of the law and discussed initial steps for implementation.
• Fact Sheet Detailing Major Provisions of Healthcare Reform: This summary document provides an overview of the provisions of healthcare reform that are of interest to community behavioral health providers. Click here to view the chart and learn more about addiction and mental health benefits in health reform, expansions and improvements to Medicaid, new programs that will impact behavioral health providers, and much more. 
• Healthcare Reform Implementation Timeline: This chart provides a timeline for the implementation of the major health insurance market reform, mental health, and addiction provisions of the national healthcare reform package.
• Slides, Recording Available from Webinar on Tips for Contracting with MCOs: In another webinar in our Healthcare Reform Implementation series, Julia Gonen of DC-based law firm Feldesman Tucker Leifer Fidell LLP presented on “What to Expect When Contracting with Managed Care Organizations.” The webinar covered changes providers can expect from healthcare reform and implementation of the Wellstone-Domenici Parity Law, and how to think strategically about your relationships with managed care entities in your state.
• Issue Brief on National High Risk Health Insurance Pool Program: The national healthcare reform package establishes a temporary high-risk health insurance pool program for individuals who cannot obtain coverage in the private market because of pre-existing medical conditions, which include addiction and mental health disorders. This program, which must begin within 90 days of enactment of the law, will provide health insurance for eligible individuals through January 1, 2014, when participants will transition to new state insurance exchanges. This issue brief provides an overview of the high risk pool provisions of the healthcare reform law, ways in which it will improve on pre-existing state high risk pools, and areas of opportunity for individuals with addiction and mental health disorders and the providers that serve them.
• Fact Sheet on the Behavioral Health Workforce Legislation in the 111th Congress: The U.S. behavioral health workforce faces a shortage of providers and other professionals, particularly for individuals in rural areas, children, and the elderly.  This fact sheet provides summaries of all bills introduced in the current Congressional session to address issues related to the behavioral health workforce and includes information about the behavioral health workforce provisions that were included in healthcare reform.

National Council, NAMI Submit Comments to SSA on Disability Determinations and Substance Use Disorders

In response to a request for comments issued by the Social Security Administration (SSA) this year, the National Council and the National Alliance on Mental Illness (NAMI) have submitted suggestions on federal policies related to substance use disorders and disability determinations. In current practice, individuals with substance use disorders are often found ineligible to receive Supplemental Security Income benefits, even if they also suffer from a co-morbid condition (such as physical disability or mental illness) that would normally make them eligible for these benefits.  The National Council and NAMI comments provide information and recommendations on:

• The critical need among people disabled by mental illnesses, especially those with co-occurring disorders, for SSI income and insurance
• The types of evidence that SSA should consider to be medical evidence of drug abuse and alcoholism (DAA)
• How SSA should evaluate the claims of people who have a combination of DAA and at least one other mental impairment
• Our opposition to a period of abstinence or nonuse to determine whether DAA is material to the determination of disability

The full text of the National Council/NAMI comments is available on our website.

National Council Submits Official Comments to CMS Regarding HIT ‘Meaningful Use’ Criteria
On Jan. 13, the Centers for Medicare and Medicaid Services (CMS) released its proposed criteria for establishing “meaningful use” of electronic health records, giving an opportunity for interested parties to submit comments. Compliance with these standards will be required for providers or health organizations hoping to take advantage of the health information technology incentive payments established by the American Recovery and Reinvestment Act of 2009.

In its official comments to CMS [link to comments], the National Council identified several recommendations to facilitate the meaningful use of electronic records by community behavioral health organizations such as: 1) streamlining the way in which Eligible Professionals reassign their incentive payment to their employer (i.e. CBHO); 2) incorporating provisions in the proposed rule that proactively address the need for CBHOs to be an integral part of a transformed patient-centered health care home; and 3) adopting a more gradual approach in Stage 1 criteria for meaningful use of electronic health records. 

For background information on the proposed rule and potential impact on CBHOs, please review the National Council’s Feb. 19th webinar, “Roll Out of the HIT 'Meaningful Use' Standards and Certification Criteria.” The National Council has also prepared a Frequently Asked Questions document about the proposed rule.

CMS Issues Guidance on Medicaid Expansions Under Healthcare Reform
The Centers for Medicare and Medicaid Services (CMS) has issued a letter to State Medicaid Directors providing guidance on one of the cornerstones of the coverage expansions included in healthcare reform: a requirement that states expand Medicaid to cover all individuals under 133% of the federal poverty level, beginning in 2014. In the letter, CMS described the process by which states may begin implementing their Medicaid expansions immediately if they wish, although this is not mandated until 2014. States choosing to enact their Medicaid expansions prior to 2014 may do so without a waiver and will receive federal matching funds at their current rate. After 2014, the federal government will provide states with additional support for the expansions. The full text of the letter is available online.

GAO Reviews the Department of Veterans’ Affairs Provision of SUDs Services
In a report submitted to the House Committee on Veterans’ Affairs, Subcommittee on Health, the Government Accountability Office (GAO) found that while the Dept. of Veterans’ Affairs (VA) continues to face challenges in providing substance use disorder services, it is making efforts to improve the availability and quality of these services to veterans. GAO identified several factors that currently challenge the ability of veterans to access SUDs services including lack of appropriate staff at VA locations. Meanwhile, efforts that are underway to increase the number of facilities that can provide SUDs services, encourage the use of evidence-based practices, and monitor treatment outcomes are cited as clear strategies to improve the situation.

RESOURCES & REMINDERS

National Council Report, “Substance Use Disorders and the Person-Centered Healthcare Home”
The literature regarding the interaction between Substance Use Disorders (SUDs) and health conditions is growing. A new report from the National Council for Community Behavioral Healthcare titled Substance Use Disorders and the Person-Centered Healthcare Home, describes the features of the patient centered medical home (PCMH) and discusses evolving evidence, experience, and approaches to incorporating substance use treatment services into this model.  Behavioral health - and more specifically substance use screening and brief treatment - must be fully incorporated into the PCMH in order to successfully meet the needs of those with substance use disorders.

Parity Implementation Coalition Releases Legal Analysis of Wellstone-Domenici Parity Law
A new legal analysis of the Mental Health Parity and Addiction Equity Act (MHPAEA) regulations by the DC-based legal and advocacy firm Patton Boggs, has been released by the Parity Implementation Coalition, of which the National Council is a member. The analysis provides detailed information about the provisions of the new law and how they should be implemented. The National Council has also created a feedback form (LINK) so we can hear from you about whether your insurance provider is complying with the law. Visit our Parity website for more information.
$8 Million in Grants to Support Capacity Building for SA/HIV Prevention Services
The Substance Abuse and Mental Health Services Administration is offering $8 million in grants for programs to provide substance abuse and HIV prevention services to at-risk minority populations in communities disproportionately affected by HIV/AIDS. Up to 27 grants of $300,000 each will be awarded to colleges, universities, and community-level nonprofits. The application deadline is May 17, 2010.

Grants Available to Support Telemedicine in Rural Areas
The USDA Rural Utility Service is offering $30 million in grants to promote, support, and modernize telecommunications services in rural regions of the country. Grants of $50,000-$500,000 are available for programs that critically needed medical services over distances, using telecommunications technology to link rural providers with clinics, medical centers, or expert providers. Eligible applicants include for-profit and nonprofit rural community facilities. The application deadline is May 18, 2010.

Community Resilience and Recovery Initiative Grants Now Available
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced it is making available $4.2 million in grants to communities that have been disproportionately affected by the economic downturn to address behavioral health using a place-based, multi-pronged approach.  Program requirements include community-wide suicide prevention, family based preventive interventions, SBIRT for Alcohol, Depression, and Anxiety, and treatment services for drug courts.  Awards are for up to $1.4m per year for 4 years. Only local governments are eligible to apply.  The deadline for applications is May 28.

Seed Grants for Substance Abuse, Other Public Health Projects Now Available
The American Medical Association Foundation’s Fund for Better Health is now offering seed grants of up to $5,000 each for grassroots, public health projects that target healthy lifestyles. Up to 20 projects will be funded, including projects related to substance abuse prevention. Since the program’s inception, over 200 substance abuse-related grants have been awarded. Additional information is available online.

NAADAC Co-occurring Integrated Treatment Webinar Series
Join leading experts from the Dartmouth Psychiatric Research Center, Hazelden Recovery Services, and other national leaders for a webinar discussion of tips, tools, and techniques for evolving your mental health or addiction program into a fully integrated care provider for those with co-occurring disorders—using evidence-based practices presented in the Co-occurring Disorders Program. Upcoming webinars include “Assessing Organizational Capability” (May 12) and “Screening and Assessing Clients” (June 9). A full list of the webinars in the series, registration information, and recordings of past events are available online.

Addiction, Prevention, and Treatment Resources Available from Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation has provided many grants over the years to fund programs in addiction prevention and treatment. Now, the lessons learned, best practices, and key research findings from these programs are available online. Visit the RWJF website for more information.

SAMHSA Publication Provides Guidance on Selecting Cost-Effective SUD Prevention Programs
SAMHSA has released a new report designed to assist policymakers and other stakeholders with choosing cost-effective substance abuse prevention programs. “Substance Abuse Prevention Dollars and Cents: a Cost-Benefit Analysis” is a guide to help stakeholders select the substance abuse prevention programs that address their needs, given their available funding resources. The report is available online.